Final answer:
The statement suggesting Medicare holds EDI claims for 13 days before payment is false. Medicare processes electronic claims usually within 14 days, not as a holding period, but as a processing timeframe, and this can vary depending on a variety of factors.
Step-by-step explanation:
- The statement about Medicare holding EDI claims for 13 days before releasing them for payment is false. Typically, claims submitted to Medicare are processed through the Electronic Data Interchange (EDI) system. Processes may vary somewhat based on specific Medicare administrative contractors and policies, but Medicare does not have a standard 13-day hold period for EDI claims before they are released for payment.
- Generally, Medicare aims to process clean claims quickly, and according to the Medicare Claims Processing Manual, electronic claims are often processed within 14 calendar days. However, this is not a holding period, but rather a processing timeframe. There are circumstances where delays may occur, such as the need for additional information, issues with the claim, or system-wide processing backlogs.
- Additionally, providers that are new enrollees in Medicare may experience a 30-day hold on their claims as Medicare establishes their billing history. Nonetheless, the specific notion of a 13-day holding period as a standard policy is not accurate for Medicare EDI claims.